US Health Insurance - Is this acceptable?

  • Posted by a hidden member.
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    Nov 14, 2007 5:21 PM GMT
    Forgive me for trying to simplify a question...

    I work for a small company and they do not offer health insurance. Therefore, I need to purchase my own, which I have for the past six years (Blue Cross).

    One week's pay per month goes to premiums and deductibles (I use my deductible each year...thank you rugby).

    Basically, I'm asking, is it outrageous for a healthy, but clumsy person to spend one week's paycheck a month on health insurance and medical bills?
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    Nov 14, 2007 6:19 PM GMT
    For sure Rugger....sounds pretty rediculous to me.

    And also matters where you live. I remember years ago when i moved to Miami my insurance premium...hmmm, Blue Cross like you....more than doubled! According to them the statistical chances for bodily harm more than doubled by living in Miami-Dade I only held onto it for another year.
    Some may consider me a fool but I've since not had health insurance...just being very careful not to get into trouble. So far so good... knock on wood!

    I would suggest shopping around but BCBS has some of the best rates around so that may not help. Overall health insurance is just rediculous. Sorry man...Im with you on this...!
  • Posted by a hidden member.
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    Nov 14, 2007 7:42 PM GMT
    I'm living in Austin, TX. Austin probably helps me, but Texas probably hurts me.
  • Posted by a hidden member.
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    Nov 14, 2007 11:10 PM GMT
    Keep shopping it each year, get a higher deductible quote as well (do some math to see how you would come out), check to see that you aren't paying for some things that you don't need.
    Awful isn't it?
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    Nov 14, 2007 11:34 PM GMT
    Yes, awful. There isn't single thing that ruins my day more than when I start thinking about insurance issues.
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    Nov 14, 2007 11:53 PM GMT
    Move to the UK. More rugby. Free health care. Speak English properly. Less attitude

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    Nov 14, 2007 11:59 PM GMT
    Think about a 70% tax rate in countries that have "free" insurance then you won't feel so bad . You also have the freedom now to "go bare"and save the dough .l Next year you won't when Hillary will force you to pay for insurance.
  • Posted by a hidden member.
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    Nov 15, 2007 12:14 AM GMT
    Utter rubbish. Compare the percentage of GDP per capita spent on health amongst the developed nations and you see the US fares very badly.

    Comparing taxation across countries is to group all fiscal policy decisions together with no reason. There is no reason a nation could not provide healthcare to its citizens and do nothing else.

    And the UK does not have 70% income tax.

    There are many wonderful things here in the US. Affordability of healthcare isn't one of them
  • Posted by a hidden member.
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    Nov 15, 2007 12:28 AM GMT
    Single payer!
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    Nov 15, 2007 12:51 AM GMT
    Thanks for nothing, burninman. It's defeatists like you that are ruining it for the rest of us. Who feeds you your information anyway? Sheesh.
  • Posted by a hidden member.
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    Nov 15, 2007 12:55 AM GMT
    If I hear another bi or straight acting gay guy spew another chunk of ignorant, right-wing misinformation in order to feed someone's twisted, corrupt agenda, I'm gonna puke.

    Yes, I generalized.
  • Posted by a hidden member.
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    Nov 15, 2007 1:16 AM GMT
    I'd switch company just for health care if I were you. but here's something to consider, save your money and get medicated when you travel.
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    Nov 15, 2007 1:30 AM GMT
    That sounds outrageously high for your age, Rugger. Have you checked out HMOs? Dunno if Kaiser is in Texas, but, despite the complaints by others, I've been happy with them -- much happier than I was with Blue Cross for the 10 years earlier.

    I just got my notice of my premium and benefits next year and, to my shock, my premium actually went down a few bucks and there is no change in my benefits or co-pays.

    Where does that absurd stat about 70-pct. tax rates come from? I keep reading it everywhere. It's another of those right-wing lies that gets repeated so much people don't even question it.

    I've gotten sick twice in Europe, once needing emergency room care, and it was like being on another planet, compared to the experience in America. It's a very odd experience to go to a hospital and not worry about whether it's going to wreck you financially.
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    Nov 15, 2007 1:43 AM GMT
    I've heard HMOs were pretty bad deals actually. Maybe it's undue negative press. Can anyone shed light on this?
  • Posted by a hidden member.
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    Nov 15, 2007 1:52 AM GMT
    oh, I am so tired of people complaining about this.

    Look man, we live in a free market where the price of health insurance is subject to the laws of supply and demand. The price for insurance has obviously reached the medium price. What, are you asking for it to be subsidized commie?

    I mean, what is more important here? That you crazy communists make sure everyone has affordable health care ensuring that Americas infant mortality rate (which is higher than Cuba's and three times higher than Japan's) goes down? Are you saying that it is more important that people have access to life saving drugs, preventative treatments, and regular doctors visits than it is to keep the free markets hymen remains intact and crisp?

    Well, if your priorities with healthy, longer lives rather than an abstract principle that should have been done away with decades ago then you, sir, are a monster!
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    Nov 15, 2007 2:00 AM GMT
    Actually, the reason health care insurance is so high is because we have 15% of our population (43 million people) without health care, so the rest of us have to pay for their services.

    Plus the health care companies aren't actually in a "free market". Given the size of their PAC and their contributions to Political Campaigns (look it up), they are distinctly insulated from any real congressional intervention or oversight.

    Another reason health insurance rates are so high is the level of lawsuits against doctors and hospitals. In a litigious society such as the US, each lawsuit elevates premiums for the individuals.

    HMOs get alot of bad press, but the major difference between PPOs and HMOs are the deductibles and the allowance of going to any doctor at any time (PPOs). HMOs require you to see your generalist first for referral, and if you have a good relationship with your generalist, referrals shouldn't be a problem.

    Another thing Rugger: you should check with local legal requirements for businesses. Unless you work for a very small company AND you are a full-time freelancers, many states have laws that require companies to offer health insurance. That and the tax write-offs they receive for offering insurance makes it pretty "attractive" for most companies to offer health insurance.

    If you are a full-time freelancer, you should also look into freelancer's unions. There's one in NYC that "bundles" health care plans and reduces the monthly expenditures for participants. I'm a member of one and it's been a lifesaver. I don't ever use western doctors, but it does cover off most of my eastern medicine practices.

    Spending 25% of your income on health insurance is a bit absurd. I'd say shop around. Take a good look at how you use your health insurance and consult with a professional to see what you really need.
  • Timbales

    Posts: 13999

    Nov 15, 2007 2:10 AM GMT
    it sucks your employer doesn't offer benefits.

    check with the state and see if they offer anything, I think there is a program here in NY.
  • art_smass

    Posts: 960

    Nov 15, 2007 5:02 AM GMT
    Move to Canada and marry me. It'll be cheaper, even with the elaborate wedding I've already planned.
  • Posted by a hidden member.
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    Nov 15, 2007 5:13 AM GMT
    I suppose it has to be acceptable. You work for a living but, you are also paying for a few free riders, all of us are who work and pay taxes. You pay even more in your insurance premiums. I'm retired from the Military and so, I have the VA. You aren't paying your premiums for us Vets though, just the taxes.
    If you don't like paying high premium prices, you can blame the social entitlement programs. FDR's New Deal (Raw Deal) and LBJ's Great Society are robbing you blind.
    It will get much worse. When Social Security started, there were 35 workers for every person on Social Security. You couldn't get Social Security until you reached 65 and the average lifespan for a man was 62, 70 for women. Now people are living longer and the DINKS and anyone else who hasn't brought new citizens into the workforce whittled that down to the current 5 workers for every person on Social Security and it will soon be less than that.
    FDR and LBJ, what have they got in common?
  • metta

    Posts: 52293

    Nov 15, 2007 6:13 AM GMT

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    Today's Topics 11-11-07

    Health Care Excuses - Krugman - New York Times

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    Every Single Person, Take One Single Action, Every Single Day For Single Payer.

  • metta

    Posts: 52293

    Nov 15, 2007 6:34 AM GMT
    Even if you have insurance, it does not mean you will have it if you really need to use it.

    Health insurer tied bonuses to dropping sick policyholders

    Health insurer tied bonuses to dropping sick policyholders

    By Lisa Girion
    Los Angeles Times Staff Writer

    November 9, 2007

    One of the state's largest health insurers set goals and paid bonuses based in part on how many individual policyholders were dropped and how much money was saved.

    Woodland Hills-based Health Net Inc. avoided paying $35.5 million in medical expenses by rescinding about 1,600 policies between 2000 and 2006. During that period, it paid its senior analyst in charge of cancellations more than $20,000 in bonuses based in part on her meeting or exceeding annual targets for revoking policies, documents disclosed Thursday showed.

    The revelation that the health plan had cancellation goals and bonuses comes amid a storm of controversy over the industry-wide but long-hidden practice of rescinding coverage after expensive medical treatments have been authorized.

    These cancellations have been the recent focus of intense scrutiny by lawmakers, state regulators and consumer advocates. Although these "rescissions" are only a small portion of the companies' overall business, they typically leave sick patients with crushing medical bills and no way to obtain needed treatment.

    Most of the state's major insurers have cancellation departments or individuals assigned to review coverage applications. They typically pull a policyholder's records after major medical claims are made to ensure that the client qualified for coverage at the outset.

    The companies' internal procedures for reviewing and canceling coverage have not been publicly disclosed. Health Net's disclosures Thursday provided an unprecedented peek at a company's internal operations and marked the first time an insurer had revealed how it linked cancellations to employee performance goals and to its bottom line.

    The bonuses were disclosed at an arbitration hearing in a lawsuit brought by Patsy Bates, a Gardena hairdresser whose coverage was rescinded by Health Net in the middle of chemotherapy treatments for breast cancer. She is seeking $6 million in compensation, plus damages.

    Insurers maintain that cancellations are necessary to root out fraud and keep premiums affordable. Individual coverage is issued to only the healthiest applicants, who must disclose preexisting conditions.

    Other suits have been settled out of court or through arbitration, out of public view. Until now, none had gone to a public trial.

    Health Net had sought to keep the documents secret even after it was forced to produce them for the hearing, arguing that they contained proprietary information and could embarrass the company. But the arbitrator in the case, former Los Angeles County Superior Court Judge Sam Cianchetti, granted a motion by lawyers for The Times, opening the hearing to reporters and making public all documents produced for it.

    At a hearing on the motion, the judge said, "This clearly involves very significant public interest, and my view is the arbitration proceedings should not be confidential."

    The documents show that in 2002, the company's goal for Barbara Fowler, Health Net's senior analyst in charge of rescission reviews, was 15 cancellations a month. She exceeded that, rescinding 275 policies that year -- a monthly average of 22.9.

    More recently, her goals were expressed in financial terms. Her supervisor described 2003 as a "banner year" for Fowler because the company avoided about "$6 million in unnecessary health care expenses" through her rescission of 301 policies -- one more than her performance goal.

    In 2005, her goal was to save Health Net at least $6.5 million. Through nearly 300 rescissions, Fowler ended up saving an estimated $7 million, prompting her supervisor to write: "Barbara's successful execution of her job responsibilities have been vital to the profitability" of individual and family policies.

    State law forbids insurance companies from tying any compensation for claims reviewers to their claims decisions.

    But Health Net's lawyer, William Helvestine, told the arbitrator in his opening argument Thursday that the law did not apply to the insurer in the case because Fowler was an underwriter -- not a claims reviewer.

    Helvestine acknowledged that the company tied some of Fowler's compensation to policy cancellations, including Bates'. But he maintained that the bonuses were based on the overall performance of Fowler and the company. He also said that meeting the cancellation target was only a small factor.

    The documents showed that Fowler's annual bonuses ranged from $1,654 to $6,310. But Helvestine said that no more than $276 in any year was connected to cancellations.

    He said Fowler's supervisor, Mark Ludwig, set goals that were reasonable based on the prior year's experience.

    "I think it is insulting to those individuals to make this the focal point of this case," Helvestine said.

    Bates' lawyer, William Shernoff, said Health Net's behavior was "reprehensible."

    He said the cancellation goals and financial rewards showed that the company canceled policies in bad faith and just to save money. After all, he told the arbitrator, canceling policies was Fowler's primary job.

    "For management to set goals in advance to achieve a certain number of rescissions and target savings in the millions of dollars at the expense of seriously ill patients is cruel and reprehensible by any standards of law or decency," Shernoff said.

    The company declined requests to make Fowler available to discuss the reviews.

    Cianchetti, the arbitrator, earlier ruled the rescission invalid because Health Net had mishandled the way it sent Bates the policy when it issued coverage. At the end of the hearing, it will be up to Cianchetti to determine whether Health Net acted in bad faith and owes Bates any damages.

    The disclosures surprised regulators. A spokesman said state Insurance Commissioner Steve Poizner was troubled by the allegations.

    "Commissioner Poizner has made it clear he will not tolerate illegal rescissions," spokesman Byron Tucker said. "We are going to take a hard and close look at this case."

    In recent months, the state's health and insurance regulators have teamed to develop rules aimed at curbing rescissions and to more closely monitor the industry's cancellation policies.

    Other insurers that have rescission operations, including Blue Cross of California and Blue Shield of California, said they had no similar policies linking employee performance reviews to rescission levels. Blue Cross said it conducted audits to ensure that claims reviewers were not given any "carrots" for canceling coverage.

    Bates, who filed the suit against Health Net, owns a hair salon in a Gardena mini-mall between a liquor store and a doughnut shop. She said she was left with nearly $200,000 in medical bills and stranded in the midst of chemotherapy when Health Net canceled her coverage in January 2004.

    Bates, 51, said the first notice she had that something was awry with her coverage came while she was in the hospital preparing for lump-removal surgery.

    She said an administrator came to her room and told her the surgery, scheduled for early the next day, had been canceled because the hospital learned she had insurance problems. Health Net allowed the surgery to go forward only after Bates' daughter authorized the insurance company to charge three months of premiums in advance to her debit card, Bates alleged. Her coverage was canceled after she began post-surgical chemotherapy threatments.

    "I've got cancer, and I could die," she said in a recent interview. Health Net "walked away from the agreement. They don't care."

    Health Net contended that Bates failed to disclose a heart problem and shaved about 35 pounds off her weight on her
  • ScotXY

    Posts: 117

    Nov 15, 2007 8:10 AM GMT
    I do agree that its really insaine for you to have to pay 25% of your pay on insurance. When really the Budged ratio for most people is.

    40% pay goes to Home and rest 60% goes to rest of bills and expencse and saving. (haha right)

    But your situation id really try to look for any type of groups you are member of. or any groups you can be part of based on trade or education or ethinic backround that may have group plans that you can qualify to get into as member and get group discount.

    Blue Cross Blue Shield or other grousp have regional groups you can get to be part of tht help reduce amount of premiums you have to pay. Or ask employer to assist or match part of it with you.

    I well for almost any company I have worked for in the world of IT Support.

    I have almost always had awsome health insurance.

    Most of my employer's had partner benefits as well.

    My current company Large computer manufacturer. 4 letters.

    They have tremendous coverage and great benefits that cover almost anything.

    and its cost to have medical dental vision prescrip is like 45$ ish a paycheck.

    I have known other insureance for smaller companyes really shat on employee's.

    I think people really have to shop around for whom they want to work for in this day and age. If thats an option that is. Really consider the benefits you get with pay you get.

    For me example. new employee in my company starts Jan first. They would get 80 hours vacation 80 hours personaly leave time and 84 hours holiday time.

    On top of that they are covered from first day starting on the job with full active benefits. Pay is compeneitive at first and then more time with comany gets greater and over the market.
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    Nov 15, 2007 8:14 AM GMT
    Atari has five letters.... :icon_smile.gif
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    Nov 15, 2007 9:33 AM GMT
    I worked for an insurance company that provided health insurance for self-employed persons or persons without company paid insurance.

    I was terrible at selling insurance, but the jist of the program was that you buy into a group with a nominal membership fee. It offers you a bunch of group benefits like AAA and life insurance. Now that you are a member of the group you qualify for the group health insurance rates. Coverage is a-la-carte so you can build how much you want and the deductible varies.

    Based on how insurance works, I would pay for dental out of pocket, vision out of pocket, and select the highest deductable possible. This allows you to be covered against catastrophic medical bills. If you get stuck with several thousand in bills you are responsible for personally, hospitals will allow you to negotiate a payment plan.

    Also, I know you have posted that you switched to an environmental job and the pay is less than what you've had before. If you make less than 200% of the national poverty guidelines you may qualify for reduced rates for primary care from a Federally Qualified Health Center - which receives federal dollars to suppliment the cost of visits for low income patients. This way you can also save some money on your doctor visits. Some FQHC's also have dental and vision centers.

    Maybe one of these centers is near you:
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    Nov 15, 2007 9:42 AM GMT
    I'm at a health care conference in Las Vegas currently. The key note speaker works in DC and helps do policy advisory work.

    One of the statistics that he shared with us from a university study was that part of the health crisis in the US has to do with 'crappy' health care. I.E. stuff has to be done over on the same patient because the patient did not receive the correct treatment for the problem in the first place.

    50% of all treatment from the providers is not the currently recommended best practice in the medical field. This has to do with best practice scenarios being published in trade journals uses to educate doctors, yet doctors only read these 80% of the time time, recall it 60% of the time, apply it to a patient with the applicable symptoms 40% of the time and prescribe the correct treatment correctly 26% of the time. So the cycle to get new health care technology really deployed in our country is about 15 years.

    So nearly half of your outragious premiums is going to paying for the expected medical goofs and botched service you are going to get if you have a real problem.